Jackie's Take: What's on My Mind in Women's Wellness ✍️ 🤔 📰 

No Hot Flashes, No Problem? The Case for Proactive Hormone Therapy 👩‍⚕️ 

A friend asked me this recently over dinner, and it’s a question I hear often in clinic, in DMs, and in group chats: Should I still consider hormone therapy if I feel...fine?

Let’s start with the basics. Conventionally, hormone therapy (HT) is recommended to treat moderate to severe menopause symptoms. This includes vasomotor symptoms (VMS) like hot flashes and night sweats, as well as genitourinary syndrome of menopause (GSM), which encompasses vaginal dryness, painful sex, and urinary symptoms. It’s also FDA-approved for the prevention of osteoporosis in high-risk women. If you're experiencing these symptoms, HT remains one of the most effective and well-studied tools we have.

Beyond Symptom Relief: What Does the Evidence Say?

But increasingly, I’m hearing from some women who aren’t miserable. They feel fine—but they’re smart, proactive, and deeply tuned in to the longevity conversation. They’re seeing headlines about hormone therapy and cognitive decline, about estradiol and cardiovascular health, about testosterone for vitality—and they’re wondering: Should I start now, so I don’t have to wait until I feel worse?

It’s a fair question—and a nuanced one. The evidence for hormone therapy has evolved dramatically over the past two decades. Early large trials like the Women’s Health Initiative (WHI) used older formulations like conjugated equine estrogen and medroxyprogesterone acetate in older women, many with significant baseline co-morbidities. These studies triggered widespread caution. But newer research tells a more refined story: the benefits and risks of HT depend on what you use, how you use it, and when you start.

The “timing hypothesis” suggests that starting HT within 10 years of menopause or before age 60 may support cardiovascular and cognitive function. The ELITE trial found that women who began oral estrogen within six years of menopause saw improvements in arterial plaque, while those who started later didn’t. Additional studies suggest HT can reduce insulin resistance in healthy postmenopausal women—potentially lowering risk of pre-diabetes and Type 2 diabetes.

Cancer Risk: Sorting Fact from Fear

Understandably, many women are concerned about cancer risk, particularly breast cancer. But the risks are smaller—and more context-specific—than many realize. The increased breast cancer risk observed in WHI was tied to older formulations. More modern combinations, like transdermal estradiol with micronized progesterone, carry significantly lower risk. In some cases, estrogen alone (in women without a uterus) may even reduce breast cancer incidence and mortality.

Curious to learn more about this topic? I highly recommend the book Estrogen Matters by Dr. Avrum Bluming—a must-read for anyone navigating hormone therapy with both caution and curiosity.

A Personalized, Evidence-Based Approach

So when patients come to me unsure of what to do after an underwhelming OBGYN visit, I don’t give a yes or no. I give them a framework. We talk about family history and personal risk factors for cancer, heart disease, and osteoporosis. We talk about symptoms and long-term goals. We talk about whether they want to feel sharper at work, maintain muscle mass, or avoid fractures at 80. This isn’t about chasing youth—it’s about making informed decisions.

Today’s hormone therapy options are safer and more customizable than ever. Transdermal estradiol and micronized progesterone are associated with lower risks of blood clots, stroke, and breast cancer compared to older oral regimens.

And let’s be real—our grandmothers may have aged gracefully without hormones, but they weren’t swimming in endocrine disruptors or running businesses on five hours of sleep. We are living longer and under more pressure than ever. Wanting to use what’s in the toolbox isn’t weakness—it’s wisdom.

What About Testosterone?

Don’t overlook testosterone therapy. While not FDA-approved for women in the U.S., it’s widely used off-label for peri and postmenopausal women to improve sexual desire, energy, and lean body mass. The evidence is strong and we have decades of it. The key is working with a provider who understands female-specific dosing—this isn’t about turning into a bodybuilder, it’s about maintaining function.

Practical Steps If You’re Considering HT—Even If You Feel “Fine”

• 📋 Begin with a thorough family history and personal risk assessment—including tools like the Tyrer-Cuzick model for breast cancer risk, and consider genetic testing when appropriate.

• 🧠 Talk to a provider trained in preventive hormone therapy, not just symptom management.

• 📊 Track more than just discomfort—when you feel fine, success looks different. Pay attention to improvements in mood, mental clarity, physical recovery like increased HRV, energy, libido, and sleep. These are your wins.

• 💊 If therapy is indicated, consider hormones tailored to your individual needs and lifestyle—not defaulting to the “lowest possible dose.”

• 🔁 Reassess regularly. Your goals and physiology will evolve—and your plan should, too.

You don’t have to be in crisis to take care of yourself. And you don’t have to wait until you’re falling apart to deserve support.

The Tea: What's Trending in Women's Wellness & Culture 🍵 🛍️ 

💊 💵 Hormone Therapy & Tariffs: What You Need to Know

New U.S. tariffs on pharmaceutical imports may soon impact the cost and availability of common hormone therapies like generic estradiol patches and pills. While price hikes or supply issues may not be immediate, they’re likely coming—especially for the generics many women rely on. If you’re stable on your regimen, now’s the time to get proactive: ask your provider for a 90-day supply with refills or even a year’s worth, explore interchangeable brands with your pharmacist, and consider cash-pay or compounding options if your usual pharmacy runs into delays. (Flow Space)

🆒 ❎ Are Gen Xer’s Actually the Cool Ones? 

I think yes. In a culture obsessed with Millennials and Gen Z, Vogue makes the case that Gen X might actually be the coolest generation—unbothered, under-discussed, and quietly shaping culture from behind the scenes. Rather than oversharing or chasing virality, Gen X has embraced a kind of stylish detachment, bringing grit, humor, and depth to midlife. The article argues that their low-key confidence and refusal to center themselves might just be the ultimate power move. ⚡️ 

🥞💉 Does Stopping Your GLP Cause Rebound Weight Gain?

Many women are turning to GLP-1s like Ozempic for weight support—but a recent Scientific American piece points out that most people stop within two years, often regaining weight as hunger cues rebound and the body fights to maintain its set point.

🤔 Here are my thoughts: In my clinical practice, I see these meds—much like hormone therapy—as a valuable leg up, especially for perimenopausal women whose weight gain is metabolically and hormonally distinct from Type 2 diabetes or lifelong obesity. GLP-1s can be a powerful, temporary intervention: they quiet the noise, create space for real behavior change, and help women reconnect with their bodies during a major hormonal pivot. Yes, benefits can reverse if you stop too soon without foundational changes—but used intentionally, I’ve seen many patients successfully lower their dose or taper off entirely (though at this point, most choose not to).

👙🧘‍♀️ Menopause Retreats Are Having A Moment

A journalist shares her firsthand experience attending the new menopause retreat at Canyon Ranch—and her takeaways are telling. Wellness retreats are becoming big business, and we’ll be seeing more that center midlife women. But once you strip away the luxe trappings, many of the learnings—like advocating for a DEXA scan before age 65—are things all women should know.

What struck me most? Every single attendee said they were there—spending real money and time away from their families—because they felt dismissed by the healthcare system. Unheard. Rushed. Unseen.

💫 That’s exactly what In the Saddle was built to solve: bringing you evidence-based education, real-life tools, and the reminder that you’re not alone. (Good Housekeeping)

Wellness Wordplay: Talk the Talk 🔈️ 

Term of the Week: Social Snacking

🗣️ Social snacking is the art of micro-connection — brief, intentional interactions that feed your nervous system. A real “hi” to the dog walker. A warm exchange with your barista. A moment of actual but unexpected connection in a day ruled by logistics.

These small chats aren’t just cute — they’re clinically useful. They lower cortisol, boost mood, and remind your brain you’re not alone.

Snack often. It’s medicine. 🥨 💊 

The Group Chat Edit 📲 👯‍♂️ 

📘 To Read: Practical Optimism: The Art, Science and Practice of Exceptional Well-Being

Did you know that our brains are biased for negativity? I saw Dr. Sue Varma—an Emmy-winning psychiatrist and frequent Today Show contributor—speak at a women’s wellness event last week, and her message stuck. Her concept of Practical Optimism blends hope with habit, teaching you to meet life’s messiness with clarity and momentum. It’s not toxic positivity—it’s a learnable skill set for building a better baseline.➕😀 🧠 

🛍️ To Buy: (Almost) Flat Sandals

As a woman constantly hoofing it around NYC, I’m always on the hunt for shoes that look good and go the distance. Fun fact: research shows women’s feet widen with age— so it’s no wonder the shoes that worked at 30 suddenly feel like medieval torture devices. I just ordered these Margaux flats for summer, a brand known for comfort and available in multiple widths. Will report back. 👣 The Flat Sandal – Python Embossed. 👠 

❣️To Try: This Bedtime Routine from Gucci Westman 

Gucci Westman—celebrity makeup artist and founder of Westman Atelier—recently shared her bedtime routine in Airmail. While much of it is firmly in “aspirational wellness” territory, one detail stood out: she keeps fresh lilacs by her bed because the scent helps her unwind. It’s a simple, sensory cue that proves you don’t need a $600 silk robe to signal to your brain that it’s time to rest. 🛌 💐